Authorship inequalities in global health research: the IeDEA Southern Africa collaboration

Background The International epidemiology Databases to Evaluate AIDS conducts research in several regions, including in Southern Africa. We assessed authorship inequalities for the Southern African region, which is led by South African and Swiss investigators. Methods We analysed authorships of publications from 2007 to 2020 by gender, country income group, time and citation impact. We used 2020 World Bank categories to define income groups and the relative citation ratio (RCR) to assess citation impact. Authorship parasitism was defined as articles without authors from the countries where the study was conducted. A regression model examined the probability of different authorship positions. Results We included 313 articles. Of the 1064 contributing authors, 547 (51.4%) were women, and 223 (21.0%) were from 32 low-income/lower middle-income countries (LLMICs), 269 (25.3%) were from 13 upper middle-income countries and 572 (53.8%) were from 25 high-income countries (HICs). Most articles (150/157, 95.5%) reporting data from Southern Africa included authors from all participating countries. Women were more likely to be the first author than men (OR 1.74; 95% CI 1.06 to 2.83) but less likely to be last authors (OR 0.63; 95% CI 0.40 to 0.99). Compared with HIC, LLMIC authors were less likely to publish as first (OR 0.21; 95% CI 0.11 to 0.41) or last author (OR 0.20; 95% CI 0.09 to 0.42). The proportion of women and LLMIC first and last authors increased over time. The RCR tended to be higher, indicating greater impact, if first or last authors were from HIC (p=0.06). Conclusions This analysis of a global health collaboration co-led by South African and Swiss investigators showed little evidence of authorship parasitism. There were stark inequalities in authorship position, with women occupying more first and men more last author positions and researchers from LLMIC being ‘stuck in the middle’ on the byline. Global health research collaborations should monitor, analyse and address authorship inequalities.


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For authors who listed multiple affiliations, we defined the main affiliation as the place where the author spent most of their time when the article was published.
The percentage of Women/Men within an affiliation income category were calculated from total in the corresponding income category.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)

Figure 1. Proportion of Women authorships across the range of standardised authorship positions, with a weighted linear regression line (upper panel) and proportion of authorships by country income level with weighted cubic splines (lower panel).
Based on 157 (regional, original research) articles published by the International epidemiology Databases to Evaluate AIDS (IeDEA) in Southern Africa, 2007 to 2020.Lower income includes World Bank lower-middle income countries and low-income countries.The size of the circles is proportional to the number of authorships in each position.Lower income includes World Bank lower-middle income countries and low-income countries.
For authors who listed multiple affiliations, we defined the main affiliation as the place where the author spent most of their time when the article was published.
The percentage of Women/Men within an affiliation income category were calculated from total in the corresponding income category.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)     For authors who listed multiple affiliations, we defined the main affiliation as the place where the author spent most of their time when the article was published.
The percentage of Women/Men within an affiliation income category were calculated from total in the corresponding income category.

Figure 2 .
Figure 2. Proportion of Women authorships across the range of standardised authorship position, with a weighted linear regression line (upper panel) and proportion of authorships by country income level with weighted cubic splines (lower panel).

Figure 3 .
Figure 3. Proportion of Women authorships across the range of standardised authorship position, with a weighted linear regression line (upper panel) and proportion of authorships by country income level with weighted cubic splines (lower panel).
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)

Table 3 . Time trends: interaction between year and gender. Comparison / Authorship position Multivariable models: Interaction with year OR (95%CI) p-value Year*Gender: Women vs Men
Results from generalized multinomial regression models (GMRM) with random intercept for authors.Multivariable models adjusted for gender and income level of the country of affiliation, and additionally including an interaction between year and gender (model 1) or year and affiliation (model 2).

Table 4 . Characteristics of authors and authorships of 157 (regional, original research) articles published by the International epidemiology Databases to Evaluate AIDS (IeDEA) in Southern Africa, 2007 to 2020.
Lower income includes World Bank lower-middle income countries and low-income countries.

Table 8 . Characteristics of authors and authorships of 61 other publications (methods papers, commentaries, systematic reviews) acknowledging the grant of the International epidemiology Databases to Evaluate AIDS (IeDEA) in Southern Africa, 2007 to 2020.
Authorships from two single-author publications were treated as first authorships.Lower-income includes World Bank lower-middle income countries and low-income countries. *

Table 9 . Associations of gender and country of affiliation with authorship position on 61 other publications (methods papers, commentaries, systematic reviews) acknowledging the grant of the International epidemiology Databases to Evaluate AIDS (IeDEA) in Southern Africa, 2007 to 2020.
Results from generalized multinomial regression model (GMRM) with random intercept for authors.Multivariable model is adjusted for gender and income level of the country of affiliation.Lower income includes World Bank lower-middle income countries and low-income countries.BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)